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choose not to seek care there. Of the 113,094 veterans residing in New Hampshire, only 42,747 are
enrolled in the VA; of those enrolled, only 28,730 receive their health care there (Veterans
Administration, FY 2012). SHARE respondents highlighted several concerns with the Veterans
Administration, including limited services, inconvenient hours of availability, and complications in
accessing services.
Navigating a complicated VA system is only part of the problem for veterans in New Hampshire. A
multitude of community services, civilian providers and healthcare entities are accessible and available
for veterans. However, navigating these systems can be equally challenging. Communication and
coordination between community providers and the VA, as well as other service agencies, can often be
difficult and often unmanaged. For the outside provider, working with the VA and military health
insurance, such as Tricare, comes with debilitating administrative demands for paperwork, and
oversight that is unappealing and poorly reimbursed. Responses provided by civilian psychologists to a
survey conducted by the New Hampshire Psychological Association (NHPA) indicated that the vast
majority of respondents were willing and interested in treating veterans in their practice, but were
troubled by low reimbursement rates and excessive administrative demands. They also shared concerns
that they may not have a deep enough understanding of the unique needs of veterans, and requested
access to more education and training.
Our State does not have an active duty military installation where service members, veterans, and their
families can easily find and utilize the imbedded supports and services. New Hampshire is also the
only State in the nation without a full service VA medical facility (or equivalent Military Treatment
Facility)* equipped to manage the wide variety of health needs of our veterans. Therefore, our
communities must be prepared to fill the gaps, lest our veterans be forced to travel out of state for
needed care. Collaboration between VA and civilian organizations, facilities, and private providers is
imperative. Coordinated access and a continuum of care that leaves little room for gaps is possible with
the plethora of services available in New Hampshire’s civilian health sector. The challenges lie with
education, both for the veterans about what is available and for the organizations about what the
veterans need. The challenges also lie with coordination, between VA and civilian providers, and
between all organizations and the veterans in their communities.
In the Spring of 2013, VA Central Office (VACO) mandated that all 152 VA Medical facilities across
the country host a “Mental Health Summit” to engage civilian mental health organizations and
providers in the coordination of care for the veterans in their communities. Last Summer, both
Manchester VA Medical Center and White River Junction VA Medical Center (located on the
Vermont/NH border) hosted their events. Both events were attended to capacity. This initiative is a
good start; the VA mandate to coordinate care and to link veterans to services in their communities
(aka: Fee-out) is ongoing. However, the challenge is two-fold: VA must uphold its duty to refer
veterans to community providers when indicated, and the community providers must be prepared to
receive them. The latter is our State’s task alone.
Stigma
Stigma is synonymous with disgrace, dishonor and shame. When one has sacrificed his or her body
and mind to serve our nation with honor, stigma becomes the new enemy. Stigma is both assigned and
self-inflicted and, therefore, must be attacked from both sides. To succeed, we must be armed with
education, compassion, and quality, accessible health care.
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